KRONİK KARACİĞER HASTALIKLARINDA TIBBİ BESLENME TEDAVİSİ

Yıl 2017, Cilt: 6 Sayı: 1, 156 - 170, 31.03.2017

Kübra Esin Fatma Nur Bingöl Gamze Akbulut

Öz

Kronik
karaciğer hastalarında malnütrisyon yaygın görülen bir komplikasyondur.
Hastalığın ilerlemesi ile birlikte malnütrisyon oranı artmaktadır. Malnütrisyon
temel olarak yetersiz ve/veya kalitesiz besin alımı, sindirim ve emilim
bozukluğu, dinlenme enerji harcamasının ve besin öğesi gereksinmesinin artması
sonucu görülmektedir. Malnütrisyonun neden
olabileceği komplikasyonları önlemek için kronik karaciğer hastalarında
malnütrisyon ve beslenme durumu değerlendirmesi yapılmalıdır. Hastaların
malnütrisyonunun tanımlanmasında ve beslenme durumunun değerlendirilmesinde
genellikle Subjektif Global Değerlendirme (SGA) yöntemi ve antropometrik
ölçümler (üst orta kol çevresi, el kavrama gücü, biyolelektrik impedans
yöntemi) kullanılmaktadır. Kronik karaciğer hastalarında malnütrisyonu önlemek
ve besin öğesi gereksinmelerini karşılamak amaçlı oral, enteral ve/veya parenteral yolla beslenme destek tedavileri uygulanmaktadır.
Beslenme tedavisi uygulanırken, hepatik ensefalopatinin ilerlemiş evreleri
hariç,  enerji ve protein kısıtlaması
yapılmamalıdır. Yine bu hastalarda az ve sık beslenmeye, düzenli gece öğünü
tüketimine dikkat edilmelidir. Kronik karaciğer hastalarında dallı zincirli
aminoasitlerin kullanımı hastalığın seyrini olumlu etkilemektedir. Alkolik
hepatitte N-asetil sisteinin; hepatik
ensefalopatide ise probiyotik ve L ornitin-aspartatın beslenme
tedavisinde alternatif olarak kullanımının olumlu sonuçlarına ilişkin
çalışmalar mevcut olup, konu ile ilgili yeni çalışmalara gereksinim
duyulmaktadır.  Sonuç olarak, yeterli ve uygun tıbbi beslenme tedavisi ile
hastaların klinik ve metabolik bulguları iyileşmekte, yaşam kaliteleri artmakta
ve sağ kalım süreleri uzamaktadır. Bu derleme çalışmada, güncel
literatür taramaları doğrultusunda kronik karaciğer hastalarının tıbbi beslenme
tedavisi üzerinde durulmuştur.

Anahtar Kelimeler

Kronik Karaciğer Hastalıkları, Beslenme, Malnütrisyon

Kaynakça

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